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HomeMy WebLinkAbout042-1035-20-000 a+ o a3°3i °o I a~i o0 I O p 69 I o ( N 4 ~ I I e°y I wo Y I I ~ I I I ti o Co h €o N r 0) 0 o I (D E a` ) 0 1 .6 c z z° I 0) c C L -N c a O N ¢ w~ (D Q I I I 3 M a M r ~ z E W O C) E E o I " o ~ v z ~ I f I € M a m a m I C o z -V U) tz- g' a a z I 5 E o N 7 m N N a N ~ O I WIN& • d As C 0 (D z m z z z o N z d l0 Its C 1 C N cc o > I cc m pa I a. lg ~ - U a +o r o ~ co Cl) aNi Np O C a .0 M G a O N I co U) E E r ° `)31 n L ov I i a s ; o00 X000 zo .2 IL IL CL If If IL v in 0 GO GO 0 N J V rn 0) } O°'0)i 0) } I N - - r Cg4 CD i3oo ~ I moo ~ ° Ea I rn ml y c t m c a N 2 m N Of m V y y O) y C N H (00 to y w .r N C H C O 0 3 O U (D _a V C o d 0) O V N O l y N C 4) W V d Q) O C, ~e O € C O N N i. H W O~ C I~ m f0 C C N N N t t a0i (D o z t fO ai a` v L0 r, ) F " = Z N 2 o H o z° y z r ~ = € = € o € a € a I o L: a L: a r~'i1~~1 v E c c c _1 A 0 CL 0 (a ~ U) PP_ FORM - STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER TOWNSHIP Gl/,er~ 'SECTION `1 T Z9 N-R-_W ADDRESS- A/. f 2 ST. CROIX COUNTY, WISCONSIN rf d✓2 .J'~1s~ 2 3 SUBDIVISION LOT , LOT SIZE Q ,aU PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM m l rw w~ INDICATE NORTH ARROW BENCHMARK:Elevation and description: Alternate benchmarks /SEPTIC cturer:-At -Liquid Cap. xvv -~K~5-~76rf ~ Rings ~d:: Manhole cover elev: Final grade elev: Tank inlet elev.: - Tank outlet elev.: fpG", y~ No. of feet from nearest road:Front , Side Rear Ft. .~o ~ From nearest prop. line:Front , Side Rear Ft. > /BV , No. of feet from: Well ? /00 , Building:_-.70 (Include this information in the above plot plan) (2 reference dimensions to septic tank) SEE REVERSE SIDE A4 0 ~ VII&Z PUMP CHAMBER Manufacturer: ".ekr 1 Liquid Capacity: Ale Pump Model2 Pump/Siphon Manufact.: Pump Size jr Elevation of inlet: Bottom of tank elevation Pump on elev.: Pump off elev.: Gallons/cycle: Alarm: Man.: Switch Type: Location Distance from nearest prop. line: Front_, Side✓, Rear _4"t.36~v Distance from: Well ,20O Building > «`O SOIL ABSORPTION SYSTEM Bed: Trench: Seepage Pit: Width: Length y~ Number of Lines:_.2._Area Built Exist. Grade Elev. Proposed Final Grade Elev. Fill depth to top of pipe: No. feet from nearest prop. line:Front Side/, Rear Ft . gyp/ No. feet from well:2 ftLNo. feet from building > 300 HOLDING TANK Manufacturer: Capacity: No. of rings used: Elevation of bottom tank: Elevation of inlet: No. feet from nearest prop. line:Front , Side Rear Ft. No. feet from: Well building_ , nearest road Alarm Manufacturer: INSPECTOR: DATE: PLUMBER ON JOB: LICENSE NUMBER: 6/90:cj A (?I VAsconsin Department of Industry, PRIVATE SEWAGE SYSTEM County: Laborand Human Relations INSPECTION REPORT Safety and Buildings Division St. Croix (ATTACH TO PERMIT) Sanitary Permit No-: GENERAL INFORMATION t RL,8ec.1 3,T29-R18, Hwy. 12 1491 66 Permit Holder's Name: ❑ City ❑ Village (R Town of: State Plan ID No.: Ralph ~orrall \ Warren 891-40680 CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: I6/O 00 t091 _ s TANK INFORMATION ELEVATION DATA '40 5 cl : n ~e Ca7~e/a~s TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septi ,~c Benchmark GCJ ' Dosing ~e'T 1JCcr(~C. CS . x. Zd' Aeration Bldg. Sewer Holding St/ Inlet TANK SETBACK INFORMATION St/0 Outlet Vnto TANK TO P/ L WELL BLDG. Ae Intake ROAD Dt Inlet „13~ C Y6 I do Septic NA D? Bottom 2, Dosing Jr~ > NA Header / Man. Aeration NA Dist. Pipe Holding Bot. System PUMP/ SHN#&N INFORMATION Final Grade Manufacturer Demand Axe. op k. &&qg .Z. 3,oa /o/, Z Model Number 0- GPM b X062 0 - Zpr~ OZ,.Z/~ TDH Lift Friction System TDH Ft Forcemain Length I Dia. :2 Dist. To Well 5.7% /0 9J SOIL ABSORPTION SYSTEM BED / T4tf1VLT- Width , Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS DIMENSIONS SETBACK SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION Type 0 re I - / CHAMBER Model Number: System: y CH UNIT DISTRIBUTION SYSTEM Header! Me ti4&W Distribution Pipe(s) 4' x Hole Size x Hole Spacing Vent To Air Intake Length Dia. Length S'J Dia. -1 p g ~ 7p w / ` ~S acin ff ` ~ SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over n /t Depth Over p xx Depth Of xx Seeded/ SudJe4- xx Mulched Bed /Trench Center Bed /Trench Edges ~ -`O Topsoil ~p El No s E] No COMMENTS: (Include ode discrepancies, persons prese ) -Y 57- Plan revision required? ❑ Yes Use other side for additional information. a 7( SBD-6710 (R 05/91) Date Inspector's Signature Cert. No. SANITARY PERMIT APPLICATION 70ILHR In accord with ILHR 83.05, Wis. Adm. Code COUNT)fj STATE Y PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than q~l/ (0 t/(/ 8% x 11 inches in size. ❑ Check if revision to previous application -See reverse side for instructions for completing this application. STATE-PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. - e-1 0/4 S, 6 PROPERTY OWNER PROPERTY LOCATION Ralph Worrall SW '/4 SE '/4, S 13 T 29 , N, R 18 E (or)® PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # XXXXXXXXXXX CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER Roberts, IWI 54023 749 3121 3333 12 11. TYPE OF BUILDING: (Check one) ❑ State Owned 0 VILL GE NEAREST ROAD ❑ Public ®1 or 2 Fam. Dwelling- # of bedrooms R EL AX N M ER( ) 111. BUILDING USE: (If building type is public, check all that apply) a ca _ lfJ~3c~' - ~~j - Q' cc 1 ❑ Apt/Condo 20 Assembly Hall 6 El Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining 4 ❑ Church/School 80 Mobile Home Park 12 ❑ Service Station/Car Wash 5 ❑ Hotel/Motel 9 ❑ Off ice/Factory 13 ❑ Other: Specify I IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1. ❑ New 2. ® Replacement 3. ❑ Replacement of 4.0 Reconnection of 5. ❑ Repair of an System System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit - Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 1:1 seepage Trench 22 In-Ground 42 El PitPri vY 13 ❑ Seepage Pit Pressure 43 ❑ Vault Privy 14 ❑ System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 1. GALLONS PER DAY 2. ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) ELEVATION Feet XXXXX Feet VII. TANK CAPACITY Site in allons Total of Prefab. Fiber- Exper. INFORMATION New lExisting Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holdin Tank XX 1 0 1 000 1 Lift Pump Tank/Si hon Chamber 800 XX 800 1 Weeks Concrete- VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name (Print): Piu nat o Stam ) *W/MPRSW No.: Business Phone Number: 3289 749 3656 Plumber's Address (Street, -City, State, Zip Code): Fogerty Hts. Rd., Roberts WI 54023 IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date issued Issuing Agent Signature Stamps) Surcharge Fee) Approved ❑ Owner Given Initial _ q~./ Adverse Determination X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety S Buildings Division, Owner, Plumber • APPLICATION FOR BAIIITAAY PCRHIT ETC-100 This application form Is to bo conplntod In full and sIgnad by the owntt(s) of the property being developed, luny Inadoquacles will only result In delays of the ptcrAIt Issuance, -Should thin development be lnttnded for ittalt by ovner/contrector,(sNac house), thon a second Lorm should be tetalned and completed vhan the property Is sold and submitted to t h I a a I I I c a vlth the ■pptopelate decd recording. Ovnsc of property Location of property 1/1 1/1, 8actlon / T~01 A v Township tt Kallln9 address /go Address o f s l i t 4 0 a k " e J u bd I v l s l o n n s *9 Lot number Ptevlout owner of property r Total ■l:t of parcel Date parcel vas cttattd / Art all cornets and lot lines ldsntlflablst y e s e s N o to this pro patty being developed for resale (spec house)? Yes _ VNo Volume ; and page Number AN recorded with the Re9latet of Deeds. - INCLUDE VITI( THIS APPLICATION THE FOLLOVINCI A VKARANTT DIID which Includes a DOCUHYHT IMBIR, VOLUIII AND PAO[ NUT(IIR, and the BIKL OT T11[. REOIBTBR Of D2RDB. In addition, a certified survey, It available, would be helpful so as to avoid delays of the reviewing process, it the deed description references to a Cettlfled Butvey Hap, the Ctrtltled Survey Hap shall also be required, ifv• PROPERTY OVIIER -CERTIFICATION---- eettlfy that all statements on this form are true to the best of •y (out) xnovledgtl that I (we) am (are) the owner(s) of the property deacclbed In this intotmatlon form, by virtue of a warranty deed recorded In the ottice of the county aeglstet of Deeds as Document J(o. presently own the proposed alto for the newagslate~I and that f (ve) obt■Intd on easement, to tun with the above deacclbed ropertyl (ve) have I.he construction of sold ayotem, and the memo lima been duly recorded InthefootIICa of the Coynty Reglater of Deedsj as Document No. ` alynatvte t Ovnec 8lynatute of Co-owner (It Appllceble) Date of elgnatute Date of ei9n4tuce z rn H STC - 105 r r a H SEPTIC TANK MAINTENANCE AGREEMENT o St. Croix County z d a ,4 H 1fj1 ReBUYER ROUTE/BOX NUMBER %2 /2. Fire Number /1/60 ZIP CITY/STATE 14 '1 Y~2 PROPERTY LOCATION:-fkL14, _ Section TAN, R_ > W, Town of 44!aer"x- , St. Croix County, Subdivision - Lot number I Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance con- I sists of pumping out the septic tank every three years or sooner, if needed, by a licensed septic tank pumper. What you put into the system can affect the function of the septic tank as a treat- ment stage in the waste disposal system. St. Croix.County residents may be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their systems properly maintained. The property owner agrees to submit to St. Croix County Zoning a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper veri- fying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if nec- essary), the septic tank is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to three year expiration. 0 E I/WE, the undersigned> have read"the above requirements and agree z cn to maintain the private sewage disposal system in accordance with x H the standards set forth, herein, as set by the Wisconsin Depart- Fu ment of Natural Resources. Certification form must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year expiration date. c SIGNED ~C14 ~-cj~e'l / DATE St. Croix County Zoning Office P.O. Box 98- Hammond, WI 54015 715-796-2239 or 715-425-8363 Sign, date and return to above address. DEVARTWNT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS IIVDU.STRY, 1 C DIVISION LABOR AND PERCOLATION TESTS (115) MADISOP.O. BOX N WI 7969 HUMAN RELATIONS 0 LHR 83.090) & Chapter 145) LOCATION: SECTION: TOWNSHIP/~: LOT NO.:BLK. NO.: SUBDIVISION NAME: SW '/4 SE '/4 13 /T29 N/R 14 (o X= M xxxx COUNTY: OWNER'S/6WV6R'& NAM - MAILING ADDRESS: t. Croix Ralph Worrall 11460 Hy 12, Roberts, WI 54023 USE One 149-3121 DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: PERCOLATION TESTS: Residence 3 none New Replace 7-22-91 7-23-91 RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-Fl LLHOLDING TANK: RECOMMENDED SYSTEM: (optional) O s ou 2S ou [Is ®u O s au ® s 0u MOUND If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s. ILHR 83.09(5)(b), indicate: Nl Floodplain, indicate Floodplain elevation: NONE PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GR UNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED EST.HIG H TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK,) B- 1 71 101.0' none 53 .9'Blssil .9'Bnsil .9'Rdsl 1.7'Rdle 1.5'RdslS&T. B- B-2 37 100.2 none 32 .7'Blsail 2'Rdsly/gr B sl w /um Rd /Y MOT. B- B- 3 55 100.2 none 47 ' ' 2-MRdial ' B- NOTE: SAT. - saturated. PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD I PERIOD PER INCH P- 1 24 0 P- P- 2 24 ione 10 1 7116 1 7/16 1 3L8 22 P- P- P- 4 hr. test. PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. SY TEM E VATION iog.o, fence line ~ I 1 I ~38 _well 1___ ; q..._ X _"-housi _ _ S0' 1 51 I E 30' - i X40 I I ~ ~ t . _ 120' r 352' - r-._ 9 T - -F 270* WS _ _ £siled l _ Scgl e; a_ d other deta_ ot>< field a to hed sheet. j 8V - 41 water w _ drive way _ . __.i r...__ . _ ~ G HY 12 - 1, the undersigned, hereby certify that the soy tests reports on this form were made by me in actor with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. NAME (print): TESTS WERE COMPLETED ON: DAVE FOGERTY PLUMBING ADDRESS: uf11 r CERTIFICATION NUMBER: PHONE NUMBER (optional): 03233 03299 "ROIRIS. WISCONSIN 54023 CST IG R . hone 749.3656 DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHRSBD-6395 (R. 10/83) - OVER - Art 1W Dave Fogerty Plumbing SEWER SYSTEMS & PERK TESTING FOGERTY HEIGHTS ROAD ROBERTS, WISCONSIN 54023 (715) 749-3656 1-10-93 Dear Ralph !-,1orrn11_, I happened to drive by vesterdav and noticed you had chisel plowed the field on which vour lift station and mound is located. Today I physically inspected the area. Someone has plowed immediately below both the lift station and mound. Ralph, you have effectively negated any protection you had regarding premature svstem failure. Worse, your system has already incurred some damage and will most certainly soon fail if farming equipment continues to operate any where in the vicinity. The number of things that can and will go wrong are to numerous to itemize here, so please, discontinue all farming practices near you system! Protect your in- vestment... Sincerely, Dave Fogerty C.C. St. Croix County Zoning Administration ~p 11 - 11QN $r CqO/~ 1393 r ~ONi OWN "coy %4~ w Mound system for Ralph Worrall SWSFH S13-T2911-R18W town of Warren, St. Croix Co. i' ~I pages #1----------plan approval application #2----- St. Croix County verification of soils #3----------soil data (115) j #4----------plot-plan view #5----------work sheet #6----------system cross section #7----------pipe lateral layout #8----------dosing chamber #9----------pump curve ,I David Fogerty 'P. 91 1 Fogerty Heights Road Roberts, Wi. 54023 , MPRSW 3289 Rz 8-7-91 AUG 19 199._ ST. CROIX COUNTY WISCONSIN i ZONING OFFICE ;ST. CROIX COUNTY COURTHOUSE 911 FOURTH STREET • HUDSON, WI 54016 1 (715) 386-4680 Aug. 13, 1991 Division of Safety and Building Bureau of Plumbing P.O. Box 7969 Madison, WI 53707 To whom it may concern: An on site investigation of the Ralph Worral property, located in the SE 1/4 of the SE 1/4 of Sec. 13, T29N-R18W, Town of Warren, St. Croix County, revealed 28" of suitable soils for an making this site suitable for a replacement mound with 12" of sand fill required. Should you have any questions, please feel free to contact this office. e Si Pcerely, Ja s nM As ant Zoning Administrator cj AUG 1 9 199' LDINGS DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, P.O. BOX 7969 LABOR AND HUMAN RELATIONS PERCOLATION TESTS (115) MADISON, WI 53707 (ILHR 83.09(1) & Chapter 145) LOCATION: SE TION: TOWNSHIP/MkiAi161PAl+~ LOT NO.: BLK. NO.: SUBDIVISION NAME: SW 1/4 SE 1/ 1 /T29 N/R (o XXXXX XXX XXXXXXXXKXX=UXXXXX COUNTY: OWNER'S WW*laR'-PI^,M MA LIN ADDR SS: t. Croix Ralph Worrall 1460 Hy 12, Roberts, WI 54023 USE Phone 149-3121 DATES OBSERVATIONS MADE NO.BEDRMS.: COMMERCIAL DE RIPTIO PROFILE DES ~1TESTS: Residence 3 none ❑New ®Replace I 7-22-91 7-23-91 RATING: S- Site suitable for system U= Site unsuitable for system CONVENTIONAL: MOUND: IN-GROUND-PR E: STISTEM-IN-FILL HOLDING TANK: RECOMMENDED SYSTEM: (optional) EIS ou as ou oS ®u oS ©u ®S 1:11 MOUND DESIGN RATE: If Percolation Tests are NOT required I If any portion of the tested area is in the under s. ILHR 83.09(5)(b), indicate: NM IL Floodplain, indicate Floodplain elevation: NONE PROFILE DESCRIPTIONS BORING TOTAL ELEVATION DEPTH T GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, OBSERVED EST. IGHE TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B•1 71 101.0' none 53 .9'Blssil .9'Bnsil .9'Rdsl 1.7'Rdls 1.5'Rds1SAT. 13- B- 37 100.2 none 32 .7'Blssil 2'Rdslw/gr B 1 who Rd Y MOT. B- B- 3 55 100.2 none 47 r -15'Brisil 2-21'Rtial t B- NOTE: SAT. - saturated. PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. pERI Dt PERIOD2 PERIOD PER INCH P- 1 24 30 2 2 2 P- P-2 24 none 10 1 7/16 1 7/16 1 31 22 P- P-3 24 1 114 P 4 hr. test. PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. SY TEM E VATION ' fence line •,38~ I 7 well X 21 5' f 50' l X - L hOUB II I e i 14'0 1 3'0 120! T 5~ 270* WS4 9 , 26-, . 4' failed nd other dat attached sheet, a _ on field • 84 water wa j ; drive way I I HY 12 - I, the undersigns hereby certify that the sot tests reports on t is form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. NAME print : TESTS WERE COMPLETED ON: DAVE FOGERTY PLUMBING ADDRESS: IJCSM$Sd a>t3ark Mer at um er CERTIFICATION NUMBER: PHONE NUMBER (optional): R S, WISCONSIN 54023 CST IG R . Pfidne 749-3656 DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R, 10/83) - OVER - Dave Fogerty Plumbing SEWER SYSTEMS & PERK TESTING FOGERTY HEIGHTS ROAD ROBERTS, WISCONSIN 54023 (715) 749-3656 RALPH WORRAL PERK TEST - PAGE TWO. E SCALE 1" - 40' d - BM, assume 100.0', top of 11 steel pipe, marked by orange stake. j] = boring. o - perk. x - upside mound corners - both at 101.0' i Septic Tank Elevation 107.9' Waterway/Lift Station Elevation 96.6' Septic Tank distance to Driveway 25' gore Holes remain open to faciliate location. DAVE FOGERTY PLUMBING Licensed Perk Tester & Plumber #3233 #3289 Fooggerty Heights Road ROSE RTS, WISCONSIN 54023 Phone 749-3656 .c r--` y AUG 19 191, i 1 I ,I i /Va ,1 o~ C, ~ ~wV , 65 D ~P PEE ~ \ I00 50 47 ~j . 1 5 r /o (7 1800 f DfsT ,yam zg 4L\ ~XS641 a3, 19~, m P e hy~„bt< n 000 CIP D (K xtsr~u~, SAC TAuK Mt1Sr gC PC- TV-) Fog 9t'rz UCTOM r $004pNt~S A149 5,WR.V_5 kEc ~s~e~r Fort iM VV_PA125_-D or- MODIFIV> (Ir NIZORMAWX WICH= iu-1R Q)3 b.•C r SEW AGE SYSYEM -~D~ /y " ~ `3 51•Y"'~. N RELATIONS APr STRY, LABO D HU lSiC~1 ~ PENCE VIP COB ~~5 50 3 1.4 plot plan-plan view -OPTIONAL WORKSHEET 1. MOUND SYSTEM 11. IN-GROUND PRESSURE SYSTEM-Continued- i. Wastewater Load, Total Daily Flow= 450 gal. 10. Force Main: 37.44 Ugpm. se s. ILHR 83. 15 (3) (c) Minimum Dosing Rate= In. Adm Code and PROVIDE A DETAILED Diameter = --2- In^• LIST OF SIZING ON PLANS. 11. Total Dynamic Head: 2. Depth to Limiting Factor = 32 V1 ft. System Head = S ft. 3. LandsloPe 9 1G Vertical Lift = 10.6 ft. 4. Distance from Dose Chamber to Friction Loss = ft. Distribution System = 170 ft. TDH = 17.41 ft. 5. Elevation Difference Between 10.9 12. Pump Selection: Pump and Distribution System = ft. Pump. IIJ ~ischarge at least 37.44 gpm 6. Absorption Area Sizing: 375 at 4 ft. total dynamic head. Zoeller Area Required = sq. ft. Pump model and manufacturer, Bed or Trench Length (B) / ft. 137 Bed or Trench Width (A) _ _8 ft, 13. Dose Volume: Trench Spacing (C) ft. 10 Times Void Volume of 82.80 7, Mound Height: Distribution Lines= gal. Fill Depth (0) = 1 ft. Daily Wastewater Volume + 113 Fill Depth Downslope (E) _ 1.2 ft. 4 Doses in 24 hrs. _ B~gal. Bed or Trench Depth (F) _ t, Backflow = ~~8gai• Cap and Topsoil Depth (G) = { ft. Minimum Dose = Sat, Cap and Topsoil Depth (H) - ft. 14, Dose Chamber: 8. Mound Length: Volume = 800 gal End Slope (K) = 10 ft, Total Mound Length (L) _ 67 ft. 111. CONVENTIONAL PRIVATE SEWAGE SYSTEM 9. Mound Width: 1. Wastewater Load, Total Dally Flow = UpslopeCorrection Factor = •94 Use s. ILHR 83.15 (3) (c), Wis. Upslope Width = ft. Adm. Code and PROVIDE DETAILED Downslope Correction Factor = LIST OF SIZING ON PLANS. Downslope Width (1) _ 11 ft. 2. Required Septic Tank Capacity = gal, Total Mound Width (W) = Z5 ft. 3. Percolation Rate = min./in. 10. Basal Area: 4. Absorption Area Sizing: Infiltrative Capacity of Refer to Table 2 in ch. LHR 83 Natural Soil = 1.2 gal./sq.ft./day and PROVIDE A DETAILED L OF Basal Area Required = '175 sq. ft. SIZING ON PLANS. Basal Area Available = 891 sq. ft. Required Area = sq. ft. ILHR 83 part of Length ft. 11. If Standard Tables from Chapter ake.used, Indicate Table # --~,Z width= ft. 12. For the Distribution Network, Use Numbers 5-14 in Section II. Number of Trench = { Trench Spacing ft. 11. IN-GROUND PRESSURE SYSTEM 5. Distribution Sys 1. Depth to Limiting Factor = 321v ft. Lateral Le th = ft. 2. Landsiope = 96 Number f Laterals = I 3. Percolation Rate = min./in. Later Spacing = In. 4, Proposed System Elevation = 02.00{t, DI ante from Sidewali to Pipe = in. 4 5. Wastewater Load, Total Daily Flow: 450 gal. ystem Elevation = ft. Use s. ILHR 83.15 (3) (c) , Wis. Adm. Code and PROVIDE A DETAILED IV. SYSTEM-IN-FILL LIST OF SIZING ON-PLANS. Fill in All items from Section Ill Required Septic Tank Capacity lOOO = gal. 6. Absorption Area Sizing: 24 V. SEPTIC TANK 1000 Percolation Rate = min./in. i. Capacity = gal. Area Required = sq. ft. 2. Manufacturer: Weeks C.P. System Length = 4Z_ ft. 3. Show Site Constructed Tank Details on Plan System Width = 6 ft. 7. Distribution Pipe Sizing: I VI. DOSING TANK Hole Sire = 4 in. 1. Capacity = 800 gal. Hole Spacing = Weeks C.P. t 3- ft. 2. Manufacturer: L: feral Lcnltlh - fl, 3. Pump Manulaclurcr• Zoe] 1pr Lalcr.d Size In. 4, Pump w(icl: f It. L.Urral tipacinµ 5, Operating Head= UiA.utcr from Sidewaii•lo Pipe 2.50 6. Flow Raw= gDm• X. Dislribullon Pipe Discharge. Rale: 7. Show Site Constructed Tank Details on Plans Number of I inks Pre 1'Ipo 16 1 low Per ripe = VII. IfOLVING 'TANK 9, Manifold Sizing: 1. Capacity = Type (center or end) - end 2. Manulacturer: ' Length = it. 3. onstructed Tank Details on Plans Diameter in. s. ) -SHOW ALL INFORMATION ON PLANS- { t DLLHR SP.rr.6761 (R.01/321 Page _ Of Straw, Marsh Hay, Or Synthetic Covering Distribution Pipe Medium Sand Topsoil F _J D E 3 EW A~~ SY % Slope III . _ ~ • f~t . 'r ~ tpv j Bed Of - 2 i Force Main Plowed co. Aggregate Layer ,,~~N R~~P-C10NS P h D_ 1 Ft. I R N 4 RRQ ~ 01 ~S~RV . p,N E 1.2 Ft. OF ~N~ F S Cross Section of A Mound System Using DEpNRj w~S~ON EN~~ A Bed For The Absorption Area F .79 Ft. S G 1 Ft. R SEE CO t A 8 Ft. H 1.5 Ft. Signed: B .47- Ft. License Number: MPRSW 3289 K 10 Ft. Date: A-7-91 L 67 Ft. j Ft. 14, Y 11 Ft. I W 28, Ft. . L J Dbservation Pipe 6 K 2.91' r A' Force Main W Distribution B'ed Of Pipe Aggregate. Observation Pipe Permanent Markers Plan View Of Mound Using A Bed For The Absorption Area Page _ Of x~. Perforated Pipe Detail- 0 Cod View )POrfordled End Cop zu'. PVC Pipt Hobs Located On 9oltom, Are Equally Ueced SYSTEM. i WAGE oL~ioE~T~oNs 0V P OMAN R r~T Qr LypUSTRY. ~pBOR pN UILDINGS ~ D-ILY',,i~ I7+ c` • j V0N E CDM CE List Hob Should Be Nesf To End Cep Distribution Pipe Layout P 45 Ft. S 3 X 36 Inches Y -i inches Hole Diameter 4 Inch] Signed: ~Lateral V2 Inch(es) License Number: Tg'RSW 3289 Manifold _ Inches Date: 8-7-91 Force Main 2 Inches # of holes/pipe 16 - Invert Elevation of Laterals102.5 - Ft. i i • i+ PAf,F GF PUMP CHAMBER CRO55 SECTICIIJ AM SPECIFICATIOH5 VENT CAP 4"C.I. VENT PIPE WEATHER PROOF APPROVED LOCKING JUNCTIOU BOX MAID OLE COVE1R 25' FROM DOOR. ~JJ~IJJ f~( YYI~C' i~~tbl~ WINDOW OR FRESH I2"MIU. AIR INTAKE GRADE I 4" MIM. I - ~ 16" /"1I IJ. COFJDUIT 18"MIN. ROVIDE tIULET I R P TI GH SEAL I I ~A I f L~~ I conj I I`~ APPROVED JOINTS I I APPROVED JOINT A I WIC I. PIPE Eli W/C.M. PIPE aN ~E~1IU"yS II EXTEIIDIAIG 3' I EXTEPIOIN6 3' ALARM ONTO SOLID SOIL 01~1TO SOLID SOIL i i I . R~N1E1' OF SA ow , C ~ fAR~~ • i I ELEV. FT SE. PUMP --J OFF D L CONCRETE BLOCK HAS SUCH APPROVAL RISER EXIT PERMI'iTEO OIJLy IF TAIJK MAWUFACTURER • SEPTIC 5P_uIFItA7; IOAJ5 E } DOSE I TANKS MAQUFACTURER: Weeks C.P. WMBER OF DOSES: 4 PER DAy I TAWK SIZE: 800 GALLONS DOSE VOLUME ' INCLUDING BACKFLOW: 140.88 GALLONS I ALARM MAUUFACTURER: tank alert f MODEL NUMBER:. n/ CAPACITIES: A= 21'5 IMCAFSOR 408.5 GALLONS SWITCH TYPE: mercury g = 2.0 INCHES OR 38 GALLONS PUMP MANUFACTURER: Zoeller c- = 7.5--INCHES OR 142..9 _ CALLOUS MODEL NUMBER: 137 D= 12 INCHES OR 228 GALLONS SWITCH TYPE: mercury NOTE: RUMP AND ALARM ARE TO BE ' i MINIMUM DISCHARGE RATE 37.44 GPM INSTALLED ON SEPARATE CIRCUITS ! VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE.. 10.9 FEET + MINIMUM NETWORK SUPPLY PRESSURE. . . . . . . 2.5 FEET FEET 170 FEET OF FORCE MAIN X 2.42 F/00 FEFRICTION FACTOR.. ''01 - TOTAL 091JAMIC. HEAD = 17.41 FEET 43 INTERNAL DIMEMSIOMS: OF TANK: LENGTH- 49 ;WIDTH 77 - ;LIQUID DEPTH 8-7-91 SIGIJEO: r G LICEMSE AI UMBER: MPR~d 3289 DATE: - HEAD/CAPACITY CURVE EFFLUENT and DEWATERING "WARNING: Model 185 should not be subjected to less than 30 feet TDH. ~ F cc w TOTAL DYNAMIC MEAD/CAPACITY PER MINUTE w w U. _ EFFLUENT AND DEWATERING w 1 2 s3-55 115 SERIES 57-59 97 137-139 161 163 165 165 188 189 FT. M Gal. Ltrs. Gal. Ltrs. Gal. Ltrs. Gal. Ltrs. Gal. Ltrs. Gal. Ltrs. Gal. Ltrs. Gal. Ltrs. Gal. Ltrs. 34 110 5 1.52 43 163 57 216 104 394 106 401 61 231 61 231 155 587 155 587 10 3.05 34 129 51 193 79 300 100 378 61 231 61 231 148 560 151 572 15 4.57 19 72 43 163 64 242 91 344 60 .227 60 227 142 537 145 549 32 1 05 20 6.10 27 104 36 136 82 310 59 223 60 227 136 515 140 530 25 7.62 8 30 74 280 57 216 59 223 128 484 133 503 100 30 9.14 65 246 55 206 58 220 90 340 121 458 127 481 30 40 12.19 46 174 46 172 55 206 75 283 105 397 114 431 50 15.24 21 80 33 125. 51 191 58 -219 90 341 100 379 95 60 18.29 15 57 43 161 36 136 71 269 85 322 2pV 70 21.34 30 114 10 • 38 51 193 70 265 90 80 24.38 14 53 28 106 54 204 90 27.43 2 8 37 140 26 100 130.48 21 79 110 8 30 Lock 19' 24.5' 26' 56' 66' 87' 73' 91' 115' 24 80 MODEL 75 89 22 > 70-- Q w = 20 V 65 MO EL a tl) 1 5 Z 18 a 16 55 MODEL O 50 16 ODE 188 14 45 12 40- 10 35 185 30: 8 17,19 25 6 20 ; A I OD L Z161 4 a15: 7 - 2 53, 5 , 0 GALLONS 10 20 30 40 50 60 70 80 90 100 X11.0 120 130 140 150 160 LITERS .0 80 16'6' 240 320 400 480 560 640 FLOW PER MINUTE Note: For Head Capacity on Model 112, industrial column-explosion proof pump, see FM 219. NET GtNtHAL rnUron cn mAJUR STATE AID & CREDIT IMPORTANT: BE SURE THIS DESCRIPTION COVERS YOUR PROPERTY S13/T29/Ri8 ACRES 7.560 FUL0 13.- 18.207D CROIX COUNTY ZONING OFFICE S cL 4-&4 EC i3i~P9FT R 18W W W 7.56 A FT OF SW S CERTIFICATION STATEMENT ell FOR UTILIZATION OF AN EXISTING SEPTIC TANK This is to certify that ~~I//have inspected the septic tank presently serving the y60 /`f'Wzil /Z residence located at: 1/4, 1/4, Sec. T N, R W, Town of VV dAAL'V`, Upon inspection, I certify that I have found the tank and baffles to be in good condition, and it appears to be functioning properly. Last time serviced -TuNf ab I Did flow back occur from absorption system? Yes( No (if no, skip next line) Approximate volume or length of time: gallo minutes N~'N ou~N Capacity: U Construction: Prefab Concrete X Steel Other Manufacurer (i f known) : 1) N K N oW 0 Age of Tank ( if known) : 0 N 11 o tIJ hj (Sign ture) (Name) Please Print (Title) ~y (License Number) ( - q f t (Date) Form to be completed by licensed plumber (x.145.06, Wisconsin Statutes) or Licensed Disposer (NR 113 Wisconsin Administrative Code) - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Plumber (applying for sanitary permit) Certification: In accepting the above statement regarding existing septic tank condition, I certify that the tank to the best of my knowledge will conform to the requirements of ILHR-83, Wis. Adm.l Code (except for inspecti opening over utlet baffle). Name CY -Signature MP/MPRS= y DAVE FOGERTY PLU 1M 5/88 Ucensed Perk Tester & Plumber 63233 63289 F Heights Road ROBE~VISCONSIN 54023 Phone 749-3656 k ST. CROIX COUNTY WISCONSIN ZONING OFFICE ST. CROIX COUNTY COURTHOUSE 911 FOURTH STREET • HUDSON, WI 54016 _ (715) 386-4680 Aug. 13, 1991 Division of Safety and Building Bureau of Plumbing P.O. Box 7969 Madison, WI 53707 To whom it may concern: An on site investigation of the Ralph Worral property, located in the SE 1/4 of the SE 1/4 of Sec. 13, T29N-R18W, Town of Warren, St. Croix County, revealed 28" of suitable soils for an making this site suitable for a replacement mound with 12" of sand fill required. Should you have any questions, please feel free to contact this office. Si cerely, James 6h&' n f As ant Zoning Administrator cj SAFETY & BUILDINGS DIVISION State of Wisconsin Department of Industry, Labor and Human Relations PRIVATE SEWAGE PLAN APPROVAL Western Regional Office 2226 Rose Street LaCrosse, Wisconsin 54603 DAVID FOGERTY Owner: RALPH WORRALL FOGERTY HIEGHTS RD 1460 HWY 12 ROBERTS WI 54023 ROBERTS WI 54023 RE: Plan Number: S91-40680 Date Approved: August 22, 1991 Gallons Per Day: 450 Date Received: August 22, 1991 Project Name: WORRALL, RALPH Location: SW,SE,13,29,18W RESIDENCE Town of WARREN County: ST CROIX The plumbing plans and specifications for this project have been reviewed for compliance with applicable code requirements. This approval is based on Chapter 145, Wisconsin Statutes and the Wisconsin Administrative Code. The plans are stamped 'conditionally approved'. This approval is contingent upon compliance with any stipulations shown on the plans. All items that are noted must be corrected. All permits required by the city, village, township or county shall be obtained prior to construction. The licensed plumber responsible for this installation shall keep one set of plans with the department's approval stamp at the construction site. The installer shall notify the appropriate inspector when inspections can be made. This approval will expire two years from the date approved or if a sanitary permit is obtained, it will expire the day the initial sanitary permit expires. The Section of Private Sewage has reviewed these plans for private sewage system code requirements only. These plans have not been reviewed for the code requirements set forth in Section ILHR 82 for general plumbing or in Chapters 50-64 of the Wisconsin Administrative code. This approval is for the following components only: - REPLACEMENT MOUND Inquiries concerning this approval may be made by calling (608) 785-9348. Sincerely, r GERARD M. SW Section of Private Sewage Division of Safety and Buildings PPP039/0009n/37 cc: RALPH WORRALL X Private Sewage Consultant S11D 6423 iR. 011911 r ----sue,- - AS BUILT SANITARY SYSTEM REPORT SEC.L R)A OWNERf TOWNSHIP ADDRESS ST. CROIX COUNTY, WISCONSIN. SUBDIVISION LOT LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of H63 THING WITHIN 100 FEET OF SYSTEM I d i a e q o~ th Arrow SC LE: _ BENCHMARK: (Permanent reference Point) Describe: o.w~l d~ B"s,E p ~-s Elevation of vertical reference oin Slope at site: n SEPTIC TANK: Manufacturer:',.'~k-~ Liquid Capacity: Number of rings on cover Tmanhole cover elevation: Tank Inlet Elevation: - Tank Outlet Elevation: PUMP CHAMBER Manufacturer: Number of gallons Number of gal. pump set or a cyc e gallons; total capacity o distribution lines gallon: size o pump head; gallon per minute horsepower rand name of pump and model number Type of warning device HOLDING TANK: Manufacturer Number of gallons Elevation of manhole cover Type of warning device - SEEPAGE PIT SIZE: umbel" o pits feet diameter--- feet liquid dept seepage pit ineft pipe-elevation _ bottom of seepage pit elevation feet. SEEPAGE BED SIZE: number of lines wi th length the deptli-~,,)o r-- SEEPAGE TRENCH: width leng h t~- PERCOLATION RATE E REQU RED Z- ZEA X U LT_ INSPECTOR DATED PLUMBER ONN JT)B-D<ir i s 10 y LICENSE NUMBER =Eli ~a REPORT OF INSPECTION - INDIVIDUAL SEWAGE SYSTEM • Sanitary Permit__ State Septic/4f 22? NAME -TOWNSHIP 4& ~ St. Croix County I.OCATION SW SectionI.-K-Lot # Subdivision SEPTIC TANK Size, 1 gallons Numr of compartments Distance from: Well Building 12% slope_ Highwater PUMPING CHAMBER Size gallons Pump Manufacturer Model Number ItOLD ING TANK Size gallons Number of Compartments- Pumper Alarm System _ I)Istance from: Well Building 12% slope Highwater ABSORPTION SITE Bed Trench Ut.stance from: Well Building__ 12% slope Highwater ✓e ABSORPTION SITE DIMENSIONS Width of trench ft Req red area ft. Length of each line ft Depth of rock below tile in. Number of lines Depth of'rock over tile Z in. Total length of lines ft Depth of tile below grade 2 in. Distance between lines ft Slope of trench in. per 100 ft. Total absortption area ft Type of Cover.: PIT DIMENSIONS Number of pits G veI around pits yes _no Outside diameter ft Depth below inlet --ft ✓r Total absorption area ft ' ft Area required INSPECTED BY TITLE_% / 8/ A P P R O V E I3-' DATE 19 ~ 7--~ - r n1 REJyv~TED DATF. 198 E A S O N FOR R E J E C T I O N d J `H `1 1 5 Rev. 9/78P REPORT ON SOIL BORINGS AND PERCOLATION TESTS ' WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES Cb 1C* P.O. BOX 309, MADISON, WISCONSIN 53701 ~r !w LOCATIONJ A-Ya, /a, Section )„3-T4 N,R ,JE (or) W, Township or Municipality Lot No. , Block No. County S ~ra ,Y Subdivision Name Owner's/Buyers Name: - Ab L A a,- 7_Z rn Mailing Address: . 4 G `i sg-i e A / JCJZ/ ~ TYPE OF OCCUPANCY: Residence L-~ No_ of Bedrooms COMMERCIAL EFFLUENT DISPOSAL SYSTEM: NEW REPLACEMENT / ALTERNATE SYSTEM OTHER DATES OBSERVATIONS MADE: SOIL BORINGS ~J PERCOLATION TESTS S ~ G - 9 SOIL MAP SHEET NAME OF SOIL MAP UNIT A m c-2- PERCOLATION TESTS TEST DEPTH CHARACTER OF SOIL HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHES RATE NUM- INCHES THICKNESS IN INCHES SINCE HOLE HOLE AFTE INTERVAL MIN/IN BER / 1ST WETTED SWELLING IN MINUTES PERIOD I PERIOD 2 PERIOD 3 P- P- P- SOIL BORING TESTS TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, NUMBER INCHES TEXTURE, MOTTLING AND DEPTH TO BEDROCK OBSERVED ESTIMATED HIGHEST IF OBSERVED IN INCHES B- l 2 7L ' L- 52 =klur -5 B- .4z I L B- 7 6/ J-7 B- S .2- 7 7~-. Gr✓- _ S B- PLAN VIEW (Locate percolation tests, soil bore holes and suitable soil areas.) Indicate on the plan the location an s, eet of suitable areas. Indicate number of square feet of absorption area needed for building type and occupancy ndicate scale or distances. Give horizontal and vertical reference points. Indicate slope. 4a _ . E CJ ~ ' Q f I . a r m e_ F N I E aA 13 s ~ ~ ~ ,lii a ~ N1 D /dv' S e t I, the undersigend, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and location of test holes are correct to the best of my knowledge and belief. Name (print) X/ e- 157 Certification No. 3 Address Name of installer if known .Copy A -Local Authority CST Signature l - APPLICATION I-aw-Ital SAFETY & BUILDINGS DEPARNMENT INNDUDUSTTRYRY, , OF FOR SANITARY DIVISION LABOR AND PERMIT P.O. BOX 7969 HUMAN RELATIONS (PLB 67) MADISON, WI 53707 Attach plans for the system on paper not less than 8% x 11 inches in size. Include a plot plan that is dimensioned or drawn to scale. Horizontal and vertical elevation reference points must be shown. All appropriate separating distances and physical characteristics as specified in chapter H-63, Wis. Adm. Code, must be shown. An index page or each page must be signed, sealed and dated by the designer. if designed 4y a Master Plumber, the date, signature and license number must be shown. The owners copy or a legible reproduction of the soil test report must be included. Property Owner: Mai in dd ss: roperty Location: thy, Village o (Township: County: ~kz '/4S i N/R (or) W Lot Number: Blk No.: T bdivision Name: Nearest Road, Lake or Landmark: State Plan I.D. Number: n (If assigned) TYPE OF BUILDING Number of ❑ Public* ❑ Variance* ❑ Other (specify)* Bedrooms: 1 or 2 Family *State Approval Required. TOTAL NUMBER PREFAB POURED-IN STEEL FIBERGLASS NEW REP'LAGE• OTHER GALLONS OF TANKS CONCRETE PLACE INSTALLATION MEIN, , (Specify) SEPTIC TANK CAPACITY HOLDING TANK CAPACITY LIFT PUMP TANK/SIPHON CHAMBER MANUFACTURER: EFFLUENT DISPOSAL SYSTEM PERCOLATION RATE ABSORPTION AREA (Minutes per inch): PROPOSED (Square feet): 14 New ❑ Replacement ❑ Experimental LY Seepage Bed ❑ Seepage Pit a~ ❑ Alternative (specify) ❑ Seepage Trench J~V Water Supply: Owner's Name as Listed on Soil Test Report (if other than present owner): Private ❑ Joint ❑ Public 1, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. Na a of Plumber: Signa e: MP/MPRSW No.: Phone Number: ) r~ (775 Plumb 's ddress: Nam of Designer: a COUNTY/DEPARTMENT USE ONLY Signa re of Issuin nt: 7 Fee: Date: APPROVED Sanitary Permit Number: L BUJ 17 (r ❑ DISAPPROVED Aefis7on for Disapproval: Alternate course(s) of Action Available: Change of ownership, building use or plumber requires a Sanitary Permit Transfer Form (67-T) to be submitted to the county prior to in- stallation. Failure to comply will void the sanitary permit. DISTRIBUTION: White-County, Canary-Bureau of Plumbing, Pink-Owner, Goldenrod-Plumber DILHR-SBD-6398 (N.03/81) a y 84/ /Y,.W 2(,a"40,0*,o /")z ~)wwlz; i v, r i If 0 i ;r . { i IV { ST. I'Y COJ VV tY VI,`I wI • see s State of I nTisconsin: ` DEPARTMENT OF TRANSPORTATION %'3 September 11, 1981 ''a TRANSPORTATION • DISTRICT 6 716 West Clalremont Avenue Eau Claire, WI 54701 Mr. Ralph Worral Route 1, Box 6 Roberts, WI 54023 Dear Mr. Worral: SUBJECT: Access Permit #55-7-81 Town of Warren St. Croix County Reference is made to the subject permit issued 7/1/81 and our telephone conversation of 9/8/81. As we advised earlier the entrance should be located no more than 500 feet west of the east entrance. As we also advised in our telephone conversation we found the distance of the driveway as constructed, to be in the neighborhood of 600 ft. west of that entrance. It is imperative that the entrance be located further east as stipulated to gain the maximum vision from the west. Again, that distance should be 500 ft. west of the east entrance. We might also mention that the distance from the west driveway is approx- imately 400 ft. Sincerely, T. R. Clark, P.E. District Director D. Gordon, P.E. Dist. Chief Maintenance Engineer GWC:mlr i { r . O S~IS~ ~ s~/s~ s~~~~~~ ~ l I y~~ ~ G ~ 32_ ~ 3~ r i ~ ~ ~ , ~l ~ cry ~f sfi' 3